深静脉置管不同部位细菌污染与导管相关感染的分析

Relationship between bacterial contamination of different deep venous catheterization sites and catheter-related infections

目的分析并探讨深静脉置管不同部位细菌污染与导管相关感染的关系,为临床感染预防工作提供指导依据。方法选取医院2010年3月-2012年3月行股静脉置管患者37例及颈静脉置管患者43例,于置管后1、3、7、14d体外段导管、管周皮肤、穿刺口位置进行细菌培养;进行不同部位细菌污染与导管污染相关性分析,并比较两种深静脉置管方法导管感染发生率。结果深静脉置管患者体外段导管、管周皮肤与穿刺口细菌培养阳性在置管术后第1、3、7天相关性明显,组间比较差异有统计学意义(P<0.05);但体外段导管、管周皮肤与穿刺口细菌培养阳性在置管术后第14天无明显相关性;股静脉置管和颈静脉置管患者导管感染发生率分别为35.1%、14.0%;颈静脉置管患者导管感染发生率明显低于股静脉置管,组间比较差异有统计学意义(P<0.05)。结论管周皮肤、体外段导管细菌感染是诱发导管感染的重要原因,穿刺口感染可作为评价导管感染情况的关键指标;颈静脉置管较股静脉置管导管感染发生风险小。

OBJECTIVE To analyze and investigate the relationship between the bacterial contamination of different deep venous catheterization sites and the catheter-related infections so as to guide the clinical prevention of the infections.METHODS A total of 37patients with femoral vein catheter and 43patients with jugular vein catheter were chosen in the period from Mar 2010to Mar 2012in the hospital for bacterial culture in vitro paragraph catheter,peritubular skin and puncture location in 1,3,7,14dafter catheterization;the relationship between bacterial contamination and catheter-related infections in different parts of deep venous catheter was analyzed,and the incidence of catheter-related infections was compared between the two types of deep venous catheterization.RESULTS There was significant relationship in positive rate of bacterial culture among vitro paragraph catheter,peritubular skin and puncture location in 1,3,7dafter catheterization（P〈0.05）.But there was no significant relationship in positive rate of bacterial culture among vitro paragraph catheter,peritubular skin and puncture location in 14dafter catheterization.The BMI and WHR of both groups were significantly better than before treatment（P〈0.05）.The improving degree on BMI and WHR of combined treatment group were significantly better than control group（P 0.05）.The incidence of the catheter-related infections of the femoral vein catheterization and the jugular vein catheterization were 35.1% and 14.0%,respectively,the incidence of catheter-related infections of the jugular vein catheterization was significantly lower than that of the femoral vein catheterization,the difference was statistically significant（P〈0.05）.CONCLUSION The bacterial contamination of vitro paragraph catheter and peritubular skin is the main cause of the catheter-related infections;the puncture location contamination can be used as the key indicator of evaluation of catheter-related infections.Compared with femoral vein catheterization,the jugular vein catheterization possesses low risk of catheter-related infections.